"In Safe Hands" - A costly integrated care program with limited benefits in stroke unit care

Area of Science:

• Health Services Research
• Clinical Quality Improvement
• Stroke Medicine

Background:

• Accountable care unit models, including structured interdisciplinary bedside rounds (SIBR), show promise in improving healthcare delivery.
• The
• In Safe Hands
• (ISH) program, incorporating SIBR, aims to enhance care coordination.
• Previous studies report reduced length of stay, potential cost savings, and improved satisfaction with SIBR.

Purpose of the Study:

• To assess the impact of implementing the ISH program on a stroke unit in Sydney, Australia.
• The study evaluated effects on length of stay, re-admission rates, adverse events, and patient/nursing satisfaction.
• To determine if ISH benefits are translatable to the Australian healthcare system and established units.

Main Methods:

• Prospective cohort study involving 200 participants.
• Data collected pre- and post-implementation of the ISH program.
• Key outcome measures included length of stay, re-admission rates, adverse events, and patient/nursing satisfaction scores.

Main Results:

• No significant difference was observed in median length of stay (5 vs. 4 days, P=0.55).
• The incidence of adverse events did not significantly change (10% vs. 12%, P=0.82).
• Stroke outcome disability scores, patient, and nursing satisfaction remained unaffected. The ISH program incurred costs of approximately AUD$1805/week.

Conclusions:

• The ISH program, despite its components, yielded limited benefits in a well-established acute stroke unit.
• The intervention proved to be costly with no significant improvements in key clinical or satisfaction outcomes.
• Further discussion is needed regarding potential reasons for the intervention's failure in this specific healthcare setting.